Reliability of postoperative photographs in assessment of facial nerve function after vestibular schwannoma resection

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This study was undertaken to assess the reliability of observations of postoperative photographs in assigning House-Brackmann scores as outcome measures for patients following resection of vestibular schwannomas.


Forty pictures of differing facial expressions typically elicited from patients for assigning House-Brackmann scores were individually evaluated by neurosurgery residents and faculty members at the University of Alabama at Birmingham; a score was assigned to each picture by the individual raters. The interrater reliability was measured using the Spearman correlation coefficient, Kendall coefficient of concordance, and kappa statistic; internal consistency was calculated using the Cronbach alpha reliability estimate.


The Spearman correlation coefficients showed strong positive association among raters, with a range of values of 0.66 to 0.90. Internal consistency measured by the Cronbach alpha coefficient was excellent (α = 0.97). The Kendall coefficient of concordance for the ordinal grades suggested a substantial degree of agreement among the raters (w = 0.76, p < 0.001).


Static postoperative photographs are a reliable outcome measure for determining facial nerve function after vestibular schwannoma resection and may serve as a surrogate for the dynamic patient interview.

Article Information

Address correspondence to: Amber S. Gordon, M.D., 1530 3rd Avenue South, Faculty Office Tower 1046, Birmingham, Alabama 35294-3410. email:

Please include this information when citing this paper: published online September 7, 2012; DOI: 10.3171/2012.8.JNS12158.

© AANS, except where prohibited by US copyright law.



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    Examples of routine postoperative photographs showing differing facial expressions that produced different levels of agreement among raters. Face at rest (A) produced 100% agreement; brow lift (B), 87.5% agreement; eyes closed (C), 37.5% agreement; smile (D), 50% agreement.


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